Aragon-Ching Jeanny B, Siegel Robert S, Frazier Harold, Andrawis Ramez, Hendricks Frederick, Phillips Michael, Jarrett Thomas, Guebre-Xabiher Hiwot, Patierno Steven, Simmens Samuel J
Division of Hematology and Oncology, Department of Medicine, The George Washington University Medical Center, Washington, DC.
Division of Hematology and Oncology, Department of Medicine, The George Washington University Medical Center, Washington, DC.
Clin Genitourin Cancer. 2015 Oct;13(5):e341-5. doi: 10.1016/j.clgc.2015.04.003. Epub 2015 Apr 18.
Circulating tumor cells (CTCs) have known prognostic implications in metastatic castration-resistant prostate cancer, but little is known regarding its utility in biochemical recurrence (BR) of prostate cancer. The primary objectives were to determine whether CTCs are measurable in patients with BR and whether it can reliably predict prostate-specific antigen (PSA) increase and PSA doubling times (PSADTs).
BR was identified in patients after prostatectomy or radiation or both, with a PSA increase of ≥ 0.2 for prior prostatectomy or > 2 mg/dL increase for post-nadir in prior radiotherapy. CTCs were enumerated at baseline at the time of study entry using the CellSearch (Janssen Diagnostics, Raritan, NJ) test.
The median age for all 36 patients accrued was 69.5 years (range, 51-91) with a median PSA of 1.65 ng/mL (range, 0.2-65.8). Gleason scores ranged from 5 to 9 (median, 7). The majority had prostatectomy (n = 25), external beam radiotherapy (n = 9), CyberKnife (Accuray, Sunnyvale, CA) (n = 1), and combined radiohormonal therapy (n = 1). PSADT ranged from 0.35 to 55 months, with a median of 7.43 months. The incidence of positive CTCs was 8.3% (3 patients), of whom 2 had biopsy-proven bony lesions on presenting with equivocal scans and PSADTs of 2.27 and 3.08 months, respectively. The third CTC-positive patient had a PSADT of 4.99 months.
Obtaining CTCs in unselected patients presenting with BR has a relatively low yield. However, obtaining a positive CTC raises the suspicion of the presence of metastatic disease and may have utility for longitudinal follow-ups of patients with BR.
循环肿瘤细胞（CTCs）在转移性去势抵抗性前列腺癌中具有已知的预后意义，但关于其在前列腺癌生化复发（BR）中的作用知之甚少。主要目的是确定BR患者中CTCs是否可检测，以及它是否能可靠地预测前列腺特异性抗原（PSA）升高和PSA倍增时间（PSADTs）。
在前列腺切除术后或放疗后或两者兼有的患者中确定BR，对于既往前列腺切除术患者，PSA升高≥0.2，对于既往放疗患者，最低点后升高>2mg/dL。在研究入组时的基线使用CellSearch（杨森诊断公司，拉里坦，新泽西州）检测对CTCs进行计数。
纳入的所有36例患者的中位年龄为69.5岁（范围51 - 91岁），中位PSA为1.65ng/mL（范围0.2 - 65.8）。 Gleason评分范围为5至9（中位数为7）。大多数患者接受了前列腺切除术（n = 25）、外照射放疗（n = 9）、射波刀（Accuray公司，桑尼维尔，加利福尼亚州）治疗（n = 1）以及联合放激素治疗（n = 1）。PSADT范围为0.35至55个月，中位数为7.43个月。CTCs阳性的发生率为8.3%（3例患者），其中2例在扫描结果不明确且PSADT分别为2.27和3.08个月时经活检证实有骨转移。第三位CTCs阳性患者的PSADT为4.99个月。
在未选择的BR患者中获取CTCs的阳性率相对较低。然而，获得阳性CTCs会增加对转移性疾病存在的怀疑，并且可能对BR患者的纵向随访有用。
